Practice Spotlight: Medication Safety Pharmacist part 2
Because the position of medication safety pharmacist was created 6 months before an accreditation survey of the CDHA by the Canadian Council on Health Services Accreditation (now known as Accreditation Canada), Ms Turple initially focused on ensuring compliance with accreditation requirements. For example, although all concentrated potassium chloride solutions had already been removed from patient care areas, concentrated potassium phosphate and hypertonic saline continued to be available. Together with the newly formed Pharmacy Medication Safety Committee, the pharmacist evaluated the clinical scenarios in which these products were being prescribed. In collaboration with many other care providers, the medication safety pharmacist undertook the following actions to address this problem:
• developed preprinted order sets for the management of hypophosphatemia, including standardization of dose-volume-solution combinations;
• coordinated in-house stability testing of premixed potassium phosphate solutions; and
• introduced a new dispensing process for potassium phosphate and hypertonic saline products.
These activities led to the successful removal of concentrated potassium phosphate from patient care areas district-wide. Removal of hypertonic saline from patient care areas is in progress.
The medication safety pharmacist is a member of the Nursing Pharmacy Committee, where her role includes sharing information gathered from the literature (e.g., from the publication Nurse Advise-ERR2) and from in-house medication incidents. This committee makes both proactive and reactive safety-related changes to nursing and pharmacy policies. For example, the High Alert Working Group, born from this committee and co- led by the medication safety pharmacist, has been tasked with the development and implementation of a policy or process for independent double checks before administration of a specified list of drugs.
In collaboration with the Risk Management department, the medication safety pharmacist has reviewed a number of internal medication incidents and investigated deficiencies in the CDHA’S systems and processes that created opportunities for error. From these investigations, the medication safety pharmacist has made recommendations for change and is active in the work required to implement the recommended changes. In a more proactive initiative based on recommendations of both ISMP and ISMP Canada, the medication safety pharmacist coordinated the removal of heparin at a concentration of 10 000 units/mL from most patient care areas in the CDHA. Floor stock was standardized to a select number of heparin products. Also, on the recommendation of CDHA’s Drugs and Therapeutics Committee, the medication safety pharmacist, working in conjunction with the Pharmacy Medication Safety Committee, has facilitated the removal from stock of several drugs of concern (as identified by ISMP), including nifedipine capsules and oral meperidine.
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An emerging role for the medication safety pharmacist is the assessment of safety features in medical devices such as infusion pumps and patient- controlled analgesia pumps. With a sound knowledge of medication safety issues and in collaboration with biomedical engineering staff, the medication safety pharmacist also participates in device purchasing decisions. Current and future initiatives include staff education related to the use of unapproved or unsafe abbreviations in the health record, development of a comprehensive allergy assessment and documentation policy, and advocacy for implementation of technologies such as automated dispensing cabinets and computerized physician order entry.
The position of medication safety pharmacist offers the opportunity to work with a variety of health care providers and to help prevent harm to patients receiving care within the CDHA. Through participation in the Medication Safety Pharmacy Specialty Network of CSHP, Ms Turple is able to learn from and share experiences with pharmacists practising in similar settings across Canada. Although the position does not allow the incumbent to provide direct patient care, all of the safety initiatives that have been implemented as a result of her activities and influence have improved the safety of direct care provided by others. This reflects the ultimate focus of the medication safety pharmacist: the safety of each individual patient.
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